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It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme is architecture. Follow us here on the blog, on Twitter and on Instagram all week to keep up with each event! #architectureMW

Rapid population growth and industrialization at the turn of the 20th century meant many Clevelanders faced a variety of health concerns associated with urban living. With large numbers of the city’s workers employed in factories, industrial accidents and occupational hazards from chronic exposure to toxic substances like lead or mercury increased at alarming rates. In recognition of these workplace dangers, many local factory owners implemented safety protocols (like not eating lunch at your lead smelting station), mandated medical check-ups, and redesigned workplaces to facilitate airflow and increase light to reduce industrial.

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The Willard Storage Battery Company received accolades from public health researchers who considered its functional architecture — a series of long buildings to increase the number of windows in each workspace — a successful way to eliminate hazardous materials while limiting the numbers of employees exposed to dangerous lead-processing areas. Although images of the factory from 1923 may trouble modern sensitivities regarding OSHA requirements, these architectural details assisted in decreasing negative health events, while improving worker retention, and productivity.

The architectural design of the Willard Storage Battery improved airflow, available light, and reduced exposure to occupational hazards. 1923.Lead smelters in the Willard Storage Battery Co. of Cleveland, OH. 1923.

Hospitals also adopted architectural features thought to promote health and limit disease spread. In keeping with conventional wisdom of the benefits of fresh air, Lakeside Hospital featured both public verandas facing the lake for charity patients and private solariums for paying patients. While domestic touches adorned private rooms, architects designed operating rooms and clinical spaces for utilitarian purposes — namely, maintaining a well-lit, aseptic environment.

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These hygienic architectural details became available consumer products for middle class Clevelanders seeking to make their homes both modern and sanitary. Through an integration of public health findings with design, the much local architecture reflects historic attempts to reduce illness and improve wellbeing.

It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme is people. Follow us here on the blog, on Twitter and on Instagram all week to keep up with each event! #peopleMW

A toothless male skull featured in a case of 19th century surgical instruments. Gift of Charles A. Muncaster, 1968.

Although the Dittrick Museum’s collections primarily focus on medical tools and artifacts, a close look around the galleries reveals a few human specimens ever ready to greet visitors with perpetual (and sometimes toothless) smiles. Like the surgical sets and pharmaceuticals they’re featured next to, these specimens were also tools — tools used to teach students about the human body.

Class Portrait from Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930

Our collections include many historic images of medical students engaged in dissection, often with each trainee’s name inscribed on the photo. Meanwhile, the identities of the cadavers, like our featured human specimens, remain unknown. Little information is available to answer questions such as: Who were these people? Why did they become objects of anatomical study?

Close-up of Muncaster Skeleton

Muncaster Skeleton through Cabinet Window

Period Room in Dittrick Museum

For example, the young male skeleton featured in our period doctor’s office came from Dr. Charles A. Muncaster, a graduate of the Western Reserve School of Medicine, class of 1919. He had acquired the specimen during his studies in 1915, a time when an articulated skeleton sold for $45 to $75. Advertisements for osteological specimens offered no details about the source of their materials, only the quality of the articulation.

Osteological Preparations from Halsam & Co. Catalog (1915).

In 1968, besides the two human specimens shown above, Muncaster donated his complete obstetrical bag, providing a snap-shot of early 20th century physician-assisted childbirth. Like Dr. Muncaster, the museum’s collections have been greatly enriched by generous patrons’ donations of their professional tools. The artifacts tell not only the stories of individual practitioners, but also of patients, education and historical understandings of health and the body.

It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme concerns secrets; join on here, on Twitter and on Instagram, to see what the buzz is about! #secretsMW

Chamberlen forceps

Secret Instruments of Medicine!In 1569, a family of Huguenots (members of the Protestant Reformed Church of France) fled religious persecution and settled in England. Their surname name was Chamberlen, and this enterprising family forever changed the world of obstetrics. Described by Bryan Hibbard as bold, undaunted, and even unethical and “rogue”-like, [1] the Chamberlens made as many enemies as friends, particularly in the practice of medicine. But they were hard-working, too, innovative and creative. Sometime in the late 16th century, Peter the elder invented an unusual device for the purpose of delivering children alive even during difficult labors. The hinged, spoon-like instrument would later be called forceps–but for the next several decades, they were known largely as “the secret.”

Spratt Forceps

Why? In an age before patents were employed by doctors or instrument makers, the family had every reason to protect their mystery device! They carried something with them that could mean life to both mother and child, and they might have done a bit of show-boating to distract the public (while marketing their services) [see our previous post]. They drove to births in closed or curtained carriages, and it is rumored that they carried “the secret” in an enormous, gold-covered box that required at least two people to carry it.

Victorian Obstetric Set

[2] It has also been recorded that patients were blind-folded and that everyone else was required to leave the room during the delivery. They even employed noisemakers and clappers to keep anyone from eave-dropping on the goings on through the adjoining door!

A family member, Hugh Chamberlen, eventually sold the secret for much needed funds–though the design had already been leaked; forceps appeared in various parts of the European continent and England, eventually making it to America and serving as a preferred tool in the early twentieth century before falling out of favor. At the Dittrick, we have a large collection of forceps; for an instrument with a singular purpose, they are surprisingly diverse!

More secrets? Breeding Rabbits’ and the Power of Instruments

Instruments played a part in uncovering at least one more ‘secret’ of birth… In 1727, Mary Toft mimicked birth pangs and contractions and fooled many into believing she had given birth to a brood of baby rabbits. The case was finally overturned by surgeon Sir Richard Manningham, who threatened to cut her open in a live vivisection. Toft confessed to the hoax–(who wouldn’t?) While Manningham’s threat was probably an empty one, it is useful case study for two reasons; first, Toft—as an uneducated woman—was thought incapable of fooling the medical men (who presumably “knew” more about birth than she). Second, Manningham’s threats were of a particularly surgical kind. The mystery of female anatomy would be rendered plain through the surgeon’s instruments.

One way or another, instrumentation had been part of how 18th c male surgeons protected their interests, for only a surgeon could wield instruments, and only those wielding instruments could be considered surgeons. The fact that only man-midwives could use forceps helped to build their practice. The rise of the man-midwife and the rise of forceps tend to go together.

Pick up any early 20th century book on infectious disease management and you’ll find confident statements assuring the victory of humans over illness and death. One text from 1909 called Mosquito or Man? speaks of this inevitable triumph over disease with an air of colonial domination, stating:

The tropical world is today being steadily and surely conquered…The campaigns show that the three great insect-carried scourges of the tropics–the greatest enemies that mankind has ever had to contend with, namely Malaria, Yellow Fever, and Sleeping Sickness–are now fully in hand and giving way, and with their conquest disappears the depression which seems to have gripped our forefathers. Now the situation is full of hope. The mosquito is no longer a nightmare; it can be got rid of.

Mouthparts anatomy of female anopheles, 1901.

Larval Anopheles anatomy, 1901.

Most European and U.S. medical attention in diseases of the “tropical world” peaked only after these conditions negatively impacted colonial interests. For example, the deaths of tens of thousands of workers from yellow fever or malaria infections (from the then-unknown mosquito vector) contributed to the failure of the 19th century French attempt to construct a canal through Panama. To create such a canal—an infrastructure project which would accelerate trade and establish imperial power—required “the economic control or eradication of the disease-conveying species…that affect personal comfort or real estate value” (LePrince and Orenstein 1916, p. 3).

Man using a knapsack carrier to spray larvicide or oil in a ditch, 1916.

By the time, the United States began their own efforts to build the Panama Canal in 1904, U.S. public health officials had already instituted extensive sanitation projects informed by new epidemiological and entomological discoveries. These measures included draining stagnant water, controlling insect-breeding areas by spraying oil and larvicide or introducing larva-eating fish, fumigating buildings, and installing mosquito netting and window screens. Although canal laborers experienced less mortality from disease than their predecessors working for the French endeavor, medical staff continued to treat thousands of cases of mosquito-borne illnesses.

Fumigation flier from 1905

Fumigation Brigade in Panama

The hard fought results from these projects came with their own costs. Draining wetlands and adding larvicides (a combination of resin, carbolic acid, and sodium hydroxide) and crude oil into the remaining standing water wrecked havoc on the local ecology (Becker et al. 2013, p. 408). During mosquito control efforts in Panama, mosquito brigades poured an estimated 160,000 gallons of oil poured into the water in a single year of construction (Canfield 1908). Meanwhile, the time and money required for mosquito control campaigns could not be permanently sustained, making the comparative ease of mosquito eradication through DDT a welcome alternative. Mosquito resistance to insecticides has renewed interests in vector control, but today’s program developers are additionally informed by the historical challenges of managing mosquitoes.

Gone is the easy confidence that mosquitos “may be destroyed” (Howard 1902). Today’s public health officials instead advise people living in mosquito-endemic areas to make difficult sacrifices to preserve their health. Although an absolute victor in the “mosquito or man” competition is both ridiculous and unlikely, it is tempting to view recent events placing mosquitoes firmly in the lead. We should remember that government officials, scientists, and physicians actually made these bold claims in a time immense of suffering and death from mosquito-transmitted diseases. Perhaps a bit of this early conviction in success (sans colonialism, of course) is necessary to fuel large-scale projects and innovation, so we can live with, rather than against, this historic foe.

Applying a layer of oil to a ditch using a horse drawn cart. Panama, 1916.

If you worked in the North American birth control industry in the latter half of the twentieth century, you would have likely encountered Percy Skuy’s museum of contraceptive curiosities. Percy was a marketing man for the Canadian arm of Ortho Pharmaceutical, a subsidiary of Johnson & Johnson dealing in contraceptives and gynaecological care. Percy would go on to become president of the company. He began amassing contraceptive devices in 1965, and the collection soon attracted interest from far and wide. It was the time that family planning was gradually becoming an acceptable topic for open discussion in North America, and Percy realized that his personal interest could be put to work as a valuable educative tool. After all, the acceptance of an abstract idea, such as family planning, is greatly aided by physical familiarity with the actual technologies that make it workable.

The collection evolved into a traveling ‘mini museum’ in a suitcase, whereby Percy could explain modern contraception’s long lineage to fascinated onlookers through a handful of key objects. The inspired ‘mini museum’ could be transported easily all over the world. Percy’s curatorial prowess soon necessitated a permanent home for the ever-expanding collection at Ortho Canada’s HQ in Don Mills. Today, the Percy Skuy Collection is on permanent display at the Dittrick Museum of Medical History. It continues to grow, year on year, as relevant technologies develop, and currently numbers over 1000 items.

The object collection is, however, but a part of the fascinating primary source material available to researchers at the Dittrick. Complimentary resources include a complete set of Ortho’s Canadian advertising for every product the Company produced. The Ortho range was not limited to contraception, but addressed the full reproductive cycle as well as gynaecological medicine. Products included Rarical iron supplement, Masse nipple cream, and menopausal therapeutics.

The Dittrick is also home to Orthos’s scrapbooks. These are substantial clippings files containing news items from the Canadian press from the 1960s through to the early 1990s covering reproductive healthcare and the multimedia dissemination of contraceptive information. For anyone with an interest in the modern history of contraception in Canada, and the legacy of Ortho as a business, the scrapbooks offer immediate submersion into the treatment of the subject by popular and trade periodicals. The scope of the scrapbooks is not limited to Ortho; they proffer an overview of the birth control business as well as the complex consumer climate over four decades of dramatic change. For example, the scrapbooks contain fascinating trade literature on packaging and marketing.

The Percy Skuy Study Centre, a private study space, offers further resources for the curious historian to explore. It contains Percy’s own personal library and is available for researchers to peruse collected contemporary materials from his long tenure at Ortho. Of particular interest are hard-copy editions of the 1970s journal Family Planning Perspectives, and various manufacturer’s pamphlets discussing contraceptive products and techniques. This combined primary source material offers rich possibilities for research. Future topics might include Ortho’s pioneering work on RH Negative babies, Canadian access and contribution to new reproductive technologies, and even the broader history of contraceptive marketing in North America. The Canadian story of contraception can also be drawn into comparative studies; as a Commonwealth nation, Canada may be of particular interest for those studying the United Kingdom.

For myself, it was trade literature clippings in the Ortho scrapbooks that proved most stimulating. I was lucky enough to be granted a Dittrick Medical History Museum and Collection study award in April 2015, which I used to undertake research for my Doctoral thesis on the condom industry. In particular, I was interested in the coverage of Ortho’s entry into the condom market in the early 1970s. Ortho was a late starter into the condom business, principally because this highly effective method of contraception and prophylaxis was looked down upon in the mid-twentieth century. This was not unusual – to some minds, condoms were associated with itinerant sexual behavior, which in itself was considered socially undesirable.

Nonetheless, by the time Ortho was ready to launch its first condom line, Conceptrol Shields, the contraceptive market had changed considerably. Oral contraceptives, which emerged in the 1960s, led to more exposure for family planning generally, and the display of rubber contraceptives had become permissible. In January 1970, Ottawa removed its restrictions on the distribution, advertising and general promotion of non-RX contraceptives, following an Ortho test campaign in the women’s magazine, Châtelaine. This meant that Ortho could exploit the new visibility of birth control with a sophisticated line of attractive consumer packaging. Shields launched in Canada October 1972, and in England the following summer. Ortho engaged Ogilvy, the advertising firm, to devise an image campaign for Shields condoms, which were billed as “the new male contraceptive for people who care”. A booklet, “A Man’s Guide to Preventing Pregnancy” was also offered free via a coupon.

I would like to extend my sincere thanks to James Edmonson, Jennifer Nieves, Brandy Schillace, Laura Travis, all of whom ensured that my time at the Dittrick was buoyant as well as productive. Last but not least, I thank Percy Skuy for his warm personal support, and without whom this wonderful collection would not be available.

Jessica Borge Bio

Jessica Borge graduated from the Institute of Historical Research, School of Advance Study, University of London, with an MA in Historical Research in 2012. She is currently an AHRC Doctoral Candidate at Birkbeck, University of London, where she is writing up her thesis, “The London Rubber Company, the Condom and the Pill in 1960s Britain”. Jessica is the joint 2015 winner of the European Association for the History of Medicine and Health Van Foreest Prize (Best Paper by a Graduate Student) and is a recent Smithsonian International Placement Scheme fellow. In April 2015, Jessica was awarded a Dittrick Medical Museum Research Studentship to work with the Percy Skuy Collection.

J e s s i c a B o r g e

AHRC Doctoral Candidate
[“The London Rubber Company, the Condom and the Pill in 1960s Britain”]
Birkbeck School of Arts
University of London

Winner: 2015 European Association for the History of Medicine and Health Van Foreest Prize
Best Paper by a Graduate Student

Recent acquisition! This cup and saucer set c. 1818 commemorates the death of Princess Charlotte after giving birth. The heir to the throne of England labored for 50 hours without intervention before delivering a large, stillborn son in 1817. Charlotte’s physicians came from the non-interventionist school of #obstetrics, meaning they used no forceps to assist or hasten the child’s stalled birth. Further, no destructive instruments (those that would have sacrificed the child to spare Charlotte) would have been used because of infant’s royal status. In fact, physicians attempted to resuscitate the stillborn baby, thinking he was in a state of “suspended animation” before attending to Charlotte’s delayed delivery of the placenta. This event forever changed the course of birth and delivery methods.

Queen Caroline and George, Prince of Wales

Who Decides, Who Delivers?

Prior to the 18th century in Britain, babies were delivered by midwives, women practitioners who had apprenticed under other women–or sometimes just an elder matron who had given birth many times herself. Then, suddenly, things began to shift. In a relatively short space of time, midwifery developed from the rare intervention of surgeons to a robust and nearly exclusive male practice. A confluence of events led to this shift, including changes in the “bodily and social event” of childbirth with the advent of lying-in hospitals, as well as changes in fashion, politics, and social structure.[i] Medical technology was the male calling card, so to speak. With the invention of the forceps, skilled surgeons (who were always men), could deliver children even in difficult or near-hopeless cases:

The more it was known [the surgeon] could deliver a living child, the less women would fear him; the less they feared him, the earlier they would call him; the earlier they called him, the more often he could deliver the child alive; and the more other this was so, the further it would be realized that he could achieve this.[ii]

Birth became a subject of medical science and of medical men, and by 1764, Queen Charlotte made William Hunter her royal obstetrician. The new age of obstetrics did not put an end to the birthing debate, however! Instead, two schools of thought arose–one that favored intervention by the obstetrician with the forceps, and one that favored non-intervention (letting nature take its course). Like Queen Charlotte, Princess Charlotte (her granddaughter) also had a physician obstetrician overseeing her pregnancy and birth–Sir Richard Croft. Unfortunately for Charlotte, Croft followed non-intervention methods and Charlotte and the baby both died.

Princess Charlotte

Croft committed suicide, feeling that he had been responsible for two deaths (and royal deaths at that). Charolotte’s funeral attracted enormous crowds of mourners–and some have compared it to the national grief that followed the death of Princess Diana.[iii]. The tragedy and its response ushered in a new age of “rational intervention” including the use of stimuli (for contractions), blood transfusion, and anesthesia.[iii] For a period of time following, no one would have criticized a princess for preferring an obstetrician and the most advanced of medical tools!

Commemoration and Change

The death of Princess Charlotte was commemorated through the sale of inexpensive transfer-wear porcelain tea cups and saucers. It may seem morbid to us, but these pieces were popular and widely used, meaning the message was also widely transmitted. If you look close, this set features a weeping #Britannia, symbolizing how the country mourned the heir’s passing. In response to her death, physicians moved toward interventionist approaches to childbirth in attempt to prevent such mortality. Texts including David Davis’s Elements of Operative #Midwifery (1825) served as important guides on the use of instruments to expedite labor.

[i] Wilson, Adrian. The Making of Man-Midwifery. (Cambridge: Harvard University Press, 1995): 6.

[ii] Wilson, Adrian. The Making of Man-Midwifery. (Cambridge: Harvard University Press, 1995): 97.

Brandy Schillace is a medical humanist, literary scholar and writer of Gothic fiction. She is the Managing Editor for Culture, Medicine, and Psychiatry, a guest curator for Dittrick Museum, and a SAGES fellow for Case Western Reserve University (she has also worked as an assistant professor of literature at Winona State). She runs the Fiction Reboot and Daily Dose blogs, leads interdisciplinary conferences abroad for IDnet, and spends a lot of her time in museums and medical libraries.

“No single event impressed me more than what happened on April 12, 1955, the day the results of the evaluation of the 1954 poliomyelitis vaccine field trials were announced. As I was making my rounds that afternoon, I was taken aback to find a banner stuck on the doors of the respirator wards that read: ‘POLIO VACCINE WORKS.’ The patients had asked the volunteers, who published an in house newsletter entitled ‘The Toomeyville Gazette,’ to spread the good news.”

Polio. Once one of the most feared of diseases, today it seems part of a past long gone and even forgotten. But there are voices that we can still hear, the lives and times of people who suffered it’s effects, and they should not be forgotten. The iron lung may be the symbol of polio’s power, its deadly means of paralyzing the lungs and suffocating patients. These iconic devices–things termed “half way” technologies by Lewis Thomas–are tools that mitigate disease effects but do not cure. And yet, these technologies were often, as James Maxwell [2] writes, a “necessary step” on the way to eradicating disease, and could be surprising innovations in themselves. Braces and belts, now empty of the limbs they meant to correct, remain full of significance. In today’s post, we examine not the cure, but the treatment–not the vaccine, but the innovative means, developed in desperation, for treating the victims of polio.

History An infectious disease caused by the poliovirus struck Cleveland (and other major cities around the country) in the early 20th century. Some 7000 died in New York in 1916, and many more were crippled by the disease. In the months that followed the outbreak, how were patients treated and what was done to prevent new epidemics? Unfortunately, the cause of the disease wasn’t well understood for many years. It grew worse in the warm months, and seemed to strike children most–though it could also infect adults. FDR contracted polio in 1921, suffering paralysis. Where did it come from? Why had it become an epidemic? And why did countries and cities with improved hygiene see the worst outbreaks?

One possible answer comes from research done at the time. Dr. Sabin, also the creator of the Sabin Oral vaccine, extensively researched developing nations. He found cases of the poliomyelitis virus, but not of paralysis or of its epidemic proportions. Nidia De Jesus sums up Sabin’s findings: Prior to the 20th century, “virtually all children were infected with PV”–but at a very young age, when they were still protected by maternal antibodies. In the 1900s, improved sanitation meant that children were much older when they encountered the virus–and no longer protected. [3] In other words, by cleaning up water systems (polio virus is carried in waste matter), hygienic measures protected people far longer. So long, in fact, that Franklin Roosevelt didn’t come in contact with it until swimming as an adult, long after any maternal antibodies might still be at work. There are some problems with the sanitation theory–it doesn’t explain, for instance, why paralytic polio is appearing now in countries where sanitation systems are less developed… Or why anomalous cases appeared even in Sabin’s time. [4] One thing was certain, however; new methods needed to be employed ahead of the vaccine, to deal with the disabled and afflicted.

Symptoms and TreatmentThree strains of polio were ultimately discovered (by David Bodian MD, PhD, in 1949), but the symptoms that alarmed physicians tended to cluster as follows: Fever, stiff neck and sore throat, stomach ache and vomiting, diarrhea, pain in the legs, and–crucially–weakness of the muscles. Paralysis often began in the extremities and moved to the lungs–and the iron lung provided relief by using a pressurized chamber to help the sufferer breath. This technology aided patients during their critical illness, but for some, the lung would be a companion for life. Other treatments focused on those who survived the disease but with permanent paralysis, weak limbs, deformity, and more. History tends to remember Dr. Jonas Salk and Dr. Albert Sabin, those who perfected the polio vaccines–but how aided those who had already contracted the disease?

Dr. John Toomey, physician and professor at Western Reserve University Medical School, was the first to recommend physical therapy for polio sufferers, including massage. Some early treatments included casts that prohibited movement, but Toomey disliked using plaster casts, arguing that in polio treatment early detection and vigorous massage were vital. He was also among the first to realize polio entered the body through the gastrointestinal tract. [5] A young man named Robert Eiben would replace Toomey upon his death in 1950, revolutionizing treatment at the Toomey Pavilion where many of the afflicted were housed and treated. The 1959 edition of the facility’s newsletter explained that “Dr. Eiben does not treat only the disease, he treats the patient.”[6] Use of physical therapy, of stretching, bracing, practiced movement, ultimately aided in rehabilitating many patients–including Donna, whose leg brace was donated to the Dittrick Museum. “I live a full and active life,” she explains; and even today, physical therapy remains part of post-polio treatment.

Did the iron lung, the leg brace, and physical therapy eradicate the disease? No, it would take the polio vaccine and an active and engaged vaccination program to do that. However, great things have come from such innovations. The iron lung paved the way for later respirator technology; the leg brace and therapy not only revolutionized care of individuals by strengthening muscles, it also engaged nurses in responsive care, giving them essential roles [7]. And finally, with the work of Drs. John Enders, Thomas Weller, and Frederick C Robbins (who joined the Cleveland City hospital staff in 1952 as Director of Pediatrics and Contagious Diseases), we took a step towards the cure.